What is body image?
‘Body image’ is a term that can be used to describe how we think and feel about our bodies.
Because these thoughts and feelings can be complex, approaches to define and understand body image are varied and can include: how we view our bodies and how accurate this perception is; how satisfied we are with our bodies and appearance; how we experience our bodies in our environment; how much we value what other people think about our bodies and appearance; and how much other people’s opinions about our appearance affect our feelings about ourselves (1–4).
Often, when we talk about ‘poor body image’, we are referring to a feeling of being unsatisfied with our body – either because of appearance, or the way it functions. This is described as ‘body dissatisfaction’. In contrast, positive body image can be described as being satisfied with our body, holding respect, appreciation and acceptance of its abilities, and having a healthy balance between valuing our body and valuing the other aspects of ourselves that make us ‘us’ (2,3,5).
How comfortable are we with our bodies?
Feeling unhappy with our appearance is a relatively common experience. The Mental Health Foundation conducted a survey with YouGov in March 2019 of 4,505 UK adults.
Our survey found that while 21% of adults felt ‘satisfied’ because of their body image, in the past year, one in five people (20%) have felt ‘shame’ and just over one third (34%) have felt ‘down or low’ in the past year because of their body image. Our survey suggests higher numbers compared to the 2013 British Social Attitudes Survey, where one in twenty men and one in ten women reported being dissatisfied with their appearance (6).
In the past year, one in five people have felt ‘shame’ and just over one third have felt ‘down or low’ in the past year because of their body image.
Body image and appreciation is relevant across our lives from youth through to later life. The proportion of women in the British Social Attitudes Survey saying they were satisfied with their appearance was similar among those aged 18–34 and those over 65 (6). This was similar in our survey, where 30% of adults aged 18–24 reported feeling ‘satisfied’ because of their body image in the last year, compared to 24% of adults aged 55+.
While women and girls are often more likely to report being unsatisfied with their bodies, men and boys are also affected by body image concerns. A survey in 2016 found that 10% of secondary school boys have said they skipped a meal to change how they look and 10% would consider taking steroids to achieve their goals (7).
As a society, we tend to place a great deal of importance on our appearance. Nearly half of adults (47%) in the British Social Attitudes Survey felt that ‘how you look affects what you can achieve in life’ and nearly one third (32%) felt that ‘your value as a person depends on how you look’ (6). Therefore, how we think and feel about our bodies is something that can affect us throughout our lives and has far-reaching implications for our feelings about ourselves, and on our mental health and wellbeing.
How does body image link to mental health?
Having body image concerns is not a mental health problem in and of itself; however, it can be a risk factor for mental health problems. Research has found that higher body dissatisfaction is associated with a poorer quality of life and psychological distress (8), a higher likelihood of depression symptoms (9,10) and the risk of unhealthy eating behaviours and eating disorders (10,11). Conversely, body satisfaction and appreciation have been linked to better overall wellbeing (12) and fewer unhealthy dieting behaviours (5,13).
This is reflected in our survey, where just over one third of adults said they felt anxious (34%) or depressed (35%) because of their body image, and just over one in eight (13%) experienced suicidal thoughts or feelings because of concerns about their body image. In a second new survey conducted by the Mental Health Foundation with YouGov in March 2019 of 1,118 GB teenagers aged 13–19, 40% felt worried, 37% felt upset, and 31% felt ashamed in relation to their body image.
One in eight adults experienced suicidal thoughts or feelings because of concerns about their body image.
Body image is closely linked to mental health problems such as body dysmorphic disorder (BDD) and eating disorders like anorexia and bulimia. BDD is a mental health problem where a person spends a lot of time worrying about flaws in their appearance that are often unnoticeable to others, to the point that it affects their daily life (14). Poor body image is both a risk factor for, and part of the diagnostic criteria of, these conditions (11). There is extensive research on the role body image plays in eating disorders, and body dysmorphia, and the ways in which these conditions can best be treated and prevented. In the current report, we focus on body image concerns in general, rather than specifically in relation to eating disorders or BDD. A review of the literature on eating disorders or BDD treatment is therefore beyond the scope of this report, but resources for further reading in this area can be found on the NHS information pages for body dysmorphic disorder and eating disorders, as well as from voluntary organisations such as Beat, Anorexia & Bulimia Care and YoungMinds. More information on the recommended guidance for treatment of eating disorders and body dysmorphic disorder can be found in the National Institute for Health and Care Excellence (NICE) guidelines.
It is important to note that body image research often looks at the characteristics of a group of people at a single point in time. This can make it hard to be sure which factors cause either poor body image or common mental health problems. For example, feeling dissatisfied with your body may cause you to feel depressed, or it may be that you are more likely to feel dissatisfied with your body if you are already experiencing depression. The research that does look at these changes over time suggests it may be a combination of the two, and that sometimes body dissatisfaction may predict or otherwise affect the development of depression or anxiety symptoms (15,16) and in other contexts, symptoms may predict body dissatisfaction (15,17).
What affects body image?
The way in which our experiences and environment affect our body image will be different for everyone. Overall, however, the research suggests that body image may be influenced by our relationships with our family and friends (18); how our family and peers feel and speak about bodies and appearance (19); exposure to images of ‘idealised’ or unrealistic bodies through the media or social media (1,20,21); and pressure to look a certain way or to match an ‘ideal’ body type (21).
Valuing and holding oneself against an unrealistic, ‘ideal’ body type is often referred to in the research as ‘internalisation of the ideal’ and is commonly linked to the development of poor body image through feelings of shame or distress when this ideal is not met (21). What this ideal looks like will shift across cultures and can vary between genders. In Western cultures, it is common for the ‘ideal’ for women to be thin body shapes, but with maintained curves (referred to as the ‘thin ideal’), while for men the ‘ideals’ are being taller and having a muscular body shape.
From a therapeutic perspective, ‘internalisation of the ideal’ can be understood as part of a process of internalising a shamed body image. Shame is an emotion that we are all born with the capacity to feel, and which, in its healthy form, can be adaptive, as it prompts us to attend to ruptures in our relationships with others by making amends and repairing interpersonal connections. In contrast, unhealthy shame is the feeling of being apart or isolated from others due to a sense of being inadequate, defective or not good enough (22). Body shame can become internalised and unhealthy when we experience consistent shaming messages about our bodies either directly (through criticism, teasing or bullying) or more indirectly (by being excluded or avoided, or consistently exposed to non-thoughtful language or unrealistic images of ‘ideal bodies’). Once internalised, this sense of shame operates regardless of how our bodies actually look or function.
All of this suggests that body image is a complex, and often very personal, experience. Its relationship to mental health is an important one, influenced by many aspects of our environment that shift and change across our lives.
Body image is a complex, and often very personal, experience.
5. Andrew R, Tiggemann M, Clark L. Predictors and Health-Related outcomes of positive body image in adolescent girls: A prospective study. Dev Psychol. 2016 Mar;52(3):463–74.
8. Griffiths S, Hay P, Mitchinson D, Mond J, McLean S, Rodgers B, et al. Sex differences in the relationships between body dissatisfaction, quality of life and psychological distress. Aust N Z J Public Health. 2016 Dec;40(6):518–22.
9. Jackson KL, Janssen I, Appelhans BM, Kazlauskaite R, Karavolos K, Dugan SA, et al. Body image satisfaction and depression in midlife women: The Study of Women’s Health Across the Nation (SWAN). Arch Womens Ment Health. 2014 Jun 13;17(3):177–87.
10. Goldschmidt AB, Wall M, Choo THJ, Becker C, Neumark-Sztainer D. Shared risk factors for mood-, eating-, and weight-related health outcomes. Heal Psychol. 2016 Mar;35(3):245–52.
11. Smolak L, Levine MP. Body Image, Disordered Eating and Eating Disorders: Connections and Disconnects. In: Smolak L, Levine MP, editors. The Wiley Handbook of Eating Disorders, Assessment, Prevention, Treatment, Policy and Future Directions. Chichester, UK: John Wiley & Sons, Ltd; 2015. p. 1–5.
12. Swami V, Weis L, Barron D, Furnham A. Positive body image is positively associated with hedonic (emotional) and eudaimonic (psychological and social) well-being in British adults. J Soc Psychol. 2018 Sep 3;158(5):541–52.
13. Gillen MM. Associations between positive body image and indicators of men’s and women’s mental and physical health. Body Image. 2015 Mar;13:67–74.
15. Sharpe H, Patalay P, Choo TH, Wall M, Mason SM, Goldschmidt AB, et al. Bidirectional associations between body dissatisfaction and depressive symptoms from adolescence through early adulthood. Dev Psychopathol. 2018 Oct 16;30(4):1447–58.
16. Vannucci A, Ohannessian CMC. Body Image Dissatisfaction and Anxiety Trajectories During Adolescence. J Clin Child Adolesc Psychol. 2018 Sep 3;47(5):785–95.
17. Bearman SK, Martinez E, Stice E, Presnell K. The Skinny on Body Dissatisfaction: A Longitudinal Study of Adolescent Girls and Boys. J Youth Adolesc. 2006 Apr;35(2):217–29.
18. Holsen I, Jones DC, Birkeland MS. Body image satisfaction among Norwegian adolescents and young adults: A longitudinal study of the influence of interpersonal relationships and BMI. Body Image. 2012 Mar;9(2):201–8.
19. Neves CM, Cipriani FM, Meireles JFF, Morgado FF da R, Ferreira MEC. Body image in childhood: An integrative literature review. Rev Paul Pediatr. 2017;35(3):331–9.
20. Holland G, Tiggemann M. A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body Image. 2016; 17:100-10.
21. Cafri G, Yamamiya Y, Brannick M, Thompson JK. The influence of sociocultural factors on body image: A meta-analysis. Clin Psychol Sci Pract. 2005 May 11;12(4):421–33.
22. DeYoung PA. Understanding and Treating Chronic Shame: A Relational/Neurobiological Approach. New York: Routledge; 2015. 190 p.